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MSP Specialist

Blue Cross and Blue Shield of Louisiana

Baton Rouge, LA

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JOB DETAILS
SKILLS
Administrative Skills, Analysis Skills, Billing, Centers for Medicare and Medicaid Services (CMS), Claims Management, Claims Processing, Collection Agency, Communication Skills, Compensation and Benefits, Computer Skills, Content Management Systems (CMS), Customer Satisfaction, Customer Support/Service, Detail Oriented, Documentation, End-Stage Renal Failure, Google Chrome Browser, Information Technology/Systems Audit, Insurance, Law Enforcement, Leadership, Legal, Maintain Compliance, Medicare, Microsoft Excel, Microsoft Internet Explorer Browser, Microsoft Office, Microsoft Outlook, Microsoft Word, Multitasking, Operations Management, Organizational Skills, People Management, Physical Demands, Presentation/Verbal Skills, Procedure Development, Record Keeping, Regulations, Research Skills, Safari Browser, Social Security Administration, Time Management, Treasury, United States Treasury, Web Browsers
LOCATION
Baton Rouge, LA
POSTED
1 day ago
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with us. Residency in or relocation to Louisiana is preferred for all positions. **POSITION PURPOSE** The MSP Specialist is responsible for analyzing, researching and resolving CMS Section 111 MSP Response File errors to ensure data exchange compliance. Responsible for determining Medicare order of payment and loading the appropriate Medicare COB record. Must be able to research and determine if 411 reporting to the MSPRC and the CMS COBC is required. Must be able to review, process and track the Small Employer Exception (SEE) approvals from CMS. Responsible for initiating procedures to recover funds from providers, subscribers or beneficiaries where overpayments have occurred. Accountable for complying with all laws and regulations that are associated with duties and responsibilities. **NATURE AND SCOPE** + This role does not manage people + This role reports to this job: SUPERVISOR, CLAIMS OPERATIONS Necessary Contacts: In order to effectively fulfill this position, the MSP Specialist must be in contact with: Various internal departments and staff including, but not limited to, Provider Services, Legal, Audit, IT, Benefits Operations Management and staff, Administrative Services and District Offices. Various external entities including, but not limited to CMS, Providers, Members, Lawyers, Groups, Commissioner of Insurance, other insurance companies, other Plans, Medicare, Medicare MSP Contractors, U.S. Department of the Treasury, and Collection Agencies. **QUALIFICATIONS** **Education** + High School Diploma or equivalent is required. **Work Experience** + 3 years of claims experience is required and + 1 year of COB, refund or adjustment experience is required + Medicare experience is preferred **Skills and Abilities** + Must have expert knowledge in primacy determination, CMS Regulations, COB Rules and Regulations is required + Knowledge of enrollment process is preferred + Must demonstrate PC skills including Microsoft Office (e.g., Word, Excel, Outlook, etc.) and related software as well as other corporate software programs and applications. + Must demonstrate verbal and communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism. + Must be able to assist both internal and external customers in a variety of situations as well as handle multiple tasks concurrently. + Must be detailed oriented and organized. + Able to shift priorities as needed to cover multiple tasks in the process as directed by leadership. **Licenses and Certifications** + None Required **ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS** + Researches, reviews, and sends appropriate documentation to Medicare/CMS, the Department of the U.S. Treasury and/or the collection agencies assigned to recoup overpayments on MSP cases. + Responsible for meeting all CMS imposed deadlines to ensure compliance, avoid referral to the Department of Treasury, and added interest charges from CMS. + Reviews, processes and tracks the Small Group Exception (SEE) approvals from CMS to ensure accuracy of enrollment and claims data. + Receives or initiates an MSP 411 investigation from tasks, MSP file, customer service etc. + Determines if 411 reporting to the MSPRC and CMS COBC are required. + Creates MSP 411 reporting letters, if applicable, when Medicare has determined primacy incorrectly and send to the MSPRC and COBC. Failure to report discrepancy could result in a daily fine up to $1,000.00 + Maintains a tracking log of all MSP 411 reported situations. + Determines if Medicare mistakenly made a Primary payment. + Researches, determines Medicare order of payment (complex research including group size, employment status, ESRD and coordinating internally with Enrollment and Billing and other areas as well as with the CMS, COBC). + Loads appropriate Medicare COB record to ensure accuracy of claims processing ensuring customer satisfaction. + Reviews the group threshold report weekly and identifies group size changes that could trigger a change in the Medicare order of payment. + Researches and makes necessary COB adjustments on claims received in MSP demand or 411 cases. + Achieves and maintains a clear understanding of all systems, applications, and procedures necessary to identify reject codes, edits, and processing codes pertaining to all claims that involve our coordination with Medicare in order to process the coordinated claims correctly. + Reviews quality audits for correction or routing within 48 hours of receipt following departmental and corporate guidelines to ensure accuracy of claims processing and customer satisfaction. + Initiates procedures to recover funds from providers, subscribers, or beneficiaries where overpayments have occurred to ensure accuracy of claims processing and financial stability. + Initiates oral and written communications with all internal departments as well as required external parties daily to complete adjustment processes and ensure a high degree of customer satisfaction. + Analyzes and corrects MSP response file errors to ensure accurate reporting to CMS as mandated under Section 111 Mandatory MSP reporting. + Maintains and records number of adjustments processed, and hours worked daily, in order to retain historical data needed to continually refine and define MSP Specialist position as needed to ensure high customer satisfaction. **Additional Accountabilities and Essential Functions** _The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions_ + Perform other job-related duties as assigned, within your scope of responsibilities. + Job duties are performed in a normal and clean office environment with normal noise levels. + Work is predominately done while standing or sitting. + The ability to comprehend, document, calculate, visualize, and analyze are required. **An Equal Opportunity Employer** **All internal employees please apply through Workday Careers.** PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI) **Additional Information** Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account. If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance. In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free. _We perform background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner._ _Additionally, we are a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results._ **JOB CATEGORY:** **Insurance**

About the Company

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Blue Cross and Blue Shield of Louisiana